This paper explores what happens in the subject when creating visual art. It is argued on the first level that there are four steps in the creation process: (i) forming the image; (ii) creating the object; (iii) the decision to finish; and (iv) the separation. On a more advanced level, one needs to be aware of the essential difference between the status of the creative process in neurosis and psychosis. It is argued that within a neurotic structure the process of creation (sublimation) witnesses the acceptance by the subject of the emptiness of the Thing behind the object created, whereas within a psychotic structure visual expression should be considered a symptom, a therapeutic phenomenon. Insight is gained into the specific way in which linguistic mechanisms enter visualisation through the case of Friedrich Schröder-Sonnenstern, a German psychotic outsider.